心内直视手术围术期减少输血的研究

Strategy to reduce allogeneic transfusion in the perioperative periods of open heart surgical procedures

目的 探讨综合性血液保护措施和新的输血指征的对减少心脏直视手术围术期输异体血的可行性。方法 395例心内直视手术按时间分为 2组 :2 0 2例为对照组 ,未采用综合性血液保护措施 ,以血红蛋白 (Hb) <12 0 g/L ,红细胞压积 (Hct) <36 %为围术期输血指征 ;193例为实验组 ,应用无血预允等综合性血液保护措施及新的输血指征 (Hb <10 0 /L ,Hct<30 % )。对两组体外循环时间、术中和术后用库血量、术后的引流量、术后并发症、术后住院时间、手术死亡率和住院总费用等进行比较 ;对两组围术期术前、术后即时、术后当晚、术后 7d、14d的Hct进行动态观察。结果 实验组有 6 8例 (35 .2 % )围术期无输血 ,术中平均输血量 (12 0 .3± 37.8)ml,术后平均输血量 (2 74 .3± 6 9.1)ml,而对照组全部病例均输血 ,术中平均输血量 (6 4 2 .1± 4 8.7)ml,术后平均输血量 (734.5± 12 7.4 )ml。两组在围术期中的输血量比较差异有显著性意义 (P <0 .0 1) ;术后住院时间、术后并发症、手术死亡率、住院总费用与术后的引流量比较差异均无显著性意义 (P >0 .0 5 ) ;两组术后Hct的动态观察均显示 ,术后 7d内有下降的趋势 ,实验组最低降至 30 % ,14d后逐渐回升。结论 应用综合性血液保护措施和新的输血指征能减少或无需在心脏直?

Objective To provide a strategy for open heart surgical procedures of reducing allogeneic transfusion in the perioperative periods.Methods A comprehensive blood conservation program and new transfusion criteria[haemoglobin(Hb)were<100g/L,hematocrit(Hct)<30%]were applied to a test group of 193 patients undergoing open heart operation from September 1998 to December 2000 in our hospital.202 patients not on blood conservation program and new transfusion triggers during surgical intervention from June 1996 to August 1998 in our hospital served as a control group.The two groups were compared with regards to the time of extracorporeal circulation,amount of allogeneic transfusion,amount of drain,the average days of hospital stay and the operative mortality were analyzed.Hct was measured during the perioperative period on the day of operation and postoperation day7,and day14.Results 68 out of the test group did not need allogeneic transfusion during perioperative periods,while all patients in the control group needed allogeneic transfusion. The average allogeneic transfusion in all patients in the test group was(120.3±37.8) ml during the operation and(274.3±69.1)ml during postoperation,respectively.In contrast,the average allogeneic transfusion in the control group was(642.1±48.7)ml during the operation and was(734.5±127.4)ml during postoperation.There were significant difference between the two groups during the operation and postoperation period( P <0.01). However,there was no significant difference in average days of hospital stay,the complication rates the operative mortality and the amount of drain postoperation between the test and control group( P >0.05).The Hct was down after operation in both groups.In the test group the Hct decreased in to 30% at day7 postoperation and regained gradually after 14 days of operation.Conclusion The dininishing allogeneic transfusion can be achieved by application of comprehensive blood conservation techniques and new transfusion criterion during the perioperative periods of open heart surgical procedures.The operative curative effect is not influence thereby.